That the draft Order laid before the House on 20 December 2016 be approved.
My Lords, the House will be aware that the immigration health charge was introduced in April 2015 and is paid by non-European Economic Area temporary migrants who apply for leave to enter for more than six months, or who apply to extend their stay. The charge, which is set at the competitive level of £200 per annum, per migrant, and at a discounted rate of £150 per annum for students and youth mobility scheme applicants, ensures that migrants make a fair and proportionate contribution to the National Health Service in a manner commensurate with their immigration status, subject to limited exceptions. Those who pay the charge and are granted leave to enter or remain in the UK currently receive NHS care in the same way as a permanent resident, subject to the same clinical need and waiting times, for as long as their leave remains valid.
In setting the level of the charge, careful consideration has been given to the range of health services available without charge to migrants, the valuable contribution that migrants make to our country and the need to ensure that the UK remains an attractive destination for global talent. Indeed, there is no evidence at present to suggest that the charge has deterred the brightest and best from coming to the UK. In 2015, the Government estimated that the introduction of the health charge could raise as much as £1.7 billion, at 2015-16 prices, over 10 years—an average of around £170 million per year. Performance in the first year of the policy was, I am pleased to say, broadly in line with these estimates.
In its first year of operation, the immigration health charge collected £164 million for spending on the NHS. Of that amount, £140.1 million was made available for spending on the NHS in 2015-16. The remainder will be made available to the NHS in 2016-17. This year, the Home Office has transferred £120 million for spending on the NHS and is expected to make a further transfer of income to the NHS before the year end. Income from the charge is shared between the NHS in England, Scotland, Wales and Northern Ireland to spend as they see fit.
The draft order before us today amends the principal order—the Immigration (Health Charge) Order 2015—in two areas. First, it removes the exemption from the health charge for intra-company transferees. Secondly, it creates a new and explicit exemption for victims of modern slavery. It also makes a number of minor and technical changes. Intra-company transferees are employees of multinational employers who are transferred to the UK either to take up a role that cannot be filled by a UK recruit, or for training purposes. It is the only route within tier 2 that is exempt from the health charge.
In 2015, the independent Migration Advisory Committee conducted a review of a number of potential changes to the tier 2 route. It was asked specifically to look at the case for applying the health charge to users of the tier 2 intra-company transfer route. While partners to the review pointed out that a large proportion of intra-company transferees may be in receipt of private healthcare, the MAC noted that they nevertheless have access to the NHS, whether they use it or not, and indeed there may be instances where they do need to make recourse to it—for example, for a GP referral to a private consultant. The MAC also noted that contributions to a universal service are not made on the basis of whether an individual makes use of that service, and that, for example, UK residents can opt for private healthcare without paying less tax to reflect their lower use of the NHS.
The MAC therefore concluded that it could not see a good reason why intra-company transferees should be exempt from payment and recommended that this group pay the health charge in line with other users of the tier 2 route. The Government accepted this recommendation and the draft order amends the principal order to that effect. The increased cost to intra-company transferees of paying the health charge is small, relative to their expected income over the duration of their stay in the UK. By applying the health charge to intra-company transferees, we estimate that an additional £136 million to £205 million could be raised for the NHS over the coming 10 years.
The second area of significant change is the explicit exemption from the health charge for victims of modern slavery. Where a victim of modern slavery has been trafficked, they already fall within an exemption on the face of the principal order. Where they have not been trafficked, the charge is waived. However, the recent review into the first six months of operation of the charge recommended that, rather than waiving the charge in these circumstances, an explicit exemption should be set out on the face of the principal order. The Government have now addressed this important point. The draft order makes it clear that all victims of modern slavery—whether trafficked or not—applying for leave under modern slavery policies fall under an explicit exemption.
My Lords, I welcome the noble Baroness to her new role. We welcome the exemptions and clarifications that she has just outlined. I should like to use this opportunity to express some concerns and ask some questions about the Government’s policy of charging foreign nationals for the use of the NHS, and how this will work.
It is right that those who are not entitled to the free use of our NHS should pay for their treatment—or it should be paid for by their insurance or their Government. Some hospitals have already introduced the policy successfully but, irrespective of its merits, the focus on collecting the equivalent of 0.5% of the NHS’s annual spend reflects the Government’s skewed priorities. It ultimately serves to mask the main challenge facing the health service—a lack of cash.
The principle that those not eligible for free NHS care should pay up front for non-urgent treatment is sound. However, there must be clear safeguards in place to prevent profiling of people who have surnames that sound “not British”, and to protect vulnerable people such as the homeless who cannot prove their right to treatment by providing the correct documents. We must also guard against any temptation to extend this policy to urgent treatment. How do the Government plan to ensure that this does not happen?
Health tourism should be properly addressed, but it is not particularly significant in terms of the overall funding of the NHS. The recent government announcement cannot mask the refusal to address the serious failures of care which are now routine across the NHS as a result of impossible financial pressures. Only this week we have heard about increases in waiting times for operations, and in unexplained deaths among those with mental health problems. One hospital trust in Kent has halted all non-urgent operations until the end of the financial year. The Government need to tackle important problems such as staff shortages and retention and a lack of social care. Recent statements reflect a warped sense of priorities. I hope that my right honourable friend Norman Lamb MP’s cross-party meeting with the Prime Minister last week will lead to a genuine consensual process to deliver a long-term settlement for the NHS and social care.
Ultimately, the NHS must not lose the humanity and compassion that are the hallmarks of an institution of which this country is rightly proud. Doctors do not see their jobs as being border guards or revenue collectors. Can the Minister assure us that clinical staff will never be expected to collect money? This would completely change the relationship between doctor and patient. Can she also assure us that hospital administrators will get funding for extra help, and if they do, will the policy be cost-effective? Talking of capacity, I heard a Minister on the radio recently whom I felt was actually encouraging people to come from abroad to use our NHS—as long as they paid for it. As waiting lists and queues in A&E and for GP appointments get longer, I would have thought the last thing we should be doing is encouraging more customers from abroad. Can the Minister say whether hospitals are charging a full cost-recovery amount—or more, or less? Does the hospital keep the money, or does it go straight to the Treasury like the rebate on drugs?
My Lords, this is the first opportunity I have had to welcome the Minister to her new role. I thank her for the explanation of the purpose and thinking behind this order which we support. It brings into effect amendments to the Immigration (Health Charge) Order 2015. That order led to an annual immigration health charge, introduced, as the Minister said, on 6 April 2015, being imposed on non-EEA nationals applying for leave to enter or remain in the UK for a limited period. Those who pay it can access NHS services free of charge, apart from payments in respect of treatments or prescriptions for which UK residents have to pay.
The Minister has set out the reasons for making the amendments provided for in this order which, in essence, remove the immigration health surcharge exemption of intra-company transferees and their dependants, extend the human trafficking exemption to include victims of modern slavery and provide greater clarity in the interpretation of some rules in the Immigration (Health Charge) Order 2015.
I have two brief points. One of the amendments in respect of ICT workers has emanated from a recommendation of the Migration Advisory Committee. Are there any committees or other bodies looking at issues that might lead to further amendments to the Immigration (Health Charge) Order 2015? Or have we now reached the stage where the Government can confirm that they have no reason to believe that further amendments will be needed in the foreseeable future—and certainly not prior to our departure from the European Union?
In the House of Commons the Government said, as the Minister has reiterated today, that the immigration health charge collected £164 million for spending on the NHS in its first year of operation. These amendments could provide an additional minimum amount of £136 million for the NHS over 10 years. Can the Government give an assurance that the money raised from the immigration health charge represents additional money for the NHS which would not have been available had the charge not been in existence? The money raised must not simply be used to enable the Government to reduce the amount they provide to the NHS by the sum raised by the health charge.
My Lords, I thank noble Lords for their contributions. I shall address the specific issues raised where I am able to do so.
I say to the noble Baroness, Lady Walmsley, that I do not think this is a case of skewed priorities. It is, indeed, right and fair that we look to overseas visitors to make a contribution to the cost of the National Health Service when they use it. The noble Baroness seemed to imply that this was not a particularly large problem. However, overseas nationals using the NHS cost the NHS £2 billion a year, which I do not think is an insignificant sum. Non-EEA migrants cost the NHS £950 million a year. Again, that is not an insignificant sum. The cost for non-EEA temporary migrants, for example, amounts to £800 per person per year, which is quite a lot.
As regards the other issues raised by the noble Baroness, I am responding on behalf of the Home Office, not the Department of Health. Therefore, I hope that noble Lords will forgive me if I refer certain issues to the Department of Health for that department to answer their questions on those issues. However, I can address certain issues. The surcharge is collected by the Home Office but the NHS is currently, and will be, responsible for ensuring that charges are collected from the right patients. However, there will also be safeguards to ensure that no vulnerable patient is denied care when they need it.
The noble Lord, Lord Rosser, asked whether there were any other committees or bodies that might make further changes to the order. Removing the exemption for intra-company transferees was a recommendation of the Migration Advisory Committee, as was mentioned. The Government are not aware of any forthcoming committees or commissions that will make recommendations in connection with the surcharge. However, as with all government policies, the health charge is kept under regular review. The noble Lord also asked whether this money was additional cash for the NHS. I can confirm that the surcharge brings in additional money to the NHS to be spent in England, Wales, Scotland and Northern Ireland. The surcharge is an important source of new income for the NHS, which is shared by the NHS across the country using the Barnett formula.
The amendments bring intra-company transferees in line with other temporary migrants and provide an important clarification in respect of victims of modern slavery. The health charge helps the NHS remain sustainable, with migrants making a fair contribution to our health services while ensuring that our country remains the destination of choice for the brightest and the best. On that basis, I commend the order to the House.
Motion to Approve
Turning to more minor changes, the draft order also amends the principal order to make it clear that applications for further leave to remain as a visitor are exempt from the charge. This is a minor, clarifying amendment that does not change the status quo. The Government have been clear from the outset that all applications for visitor visas do not attract the health charge.
The draft order strengthens the wording of the principal order to ensure that migrants granted temporary leave following a reconsideration of their application or an otherwise successful challenge to a refusal of leave must pay the charge when requested to do so. It also makes it clear that those granted an additional period of leave on appeal must also pay a health charge for that additional period. These amendments are in line with the Government’s general policy that temporary migrants should make a proportionate contribution to the NHS through payment of the charge, irrespective of the process by which leave is granted.
Finally, and in order to provide certainty for those migrants whose applications are already in train, Article 4 provides for transitional arrangements. The amendments introduced through this draft order will not apply to an immigration application submitted to the Home Office before the order comes into force.
The Government believe that it is only right and fair that migrants—including intra-company transferees—should contribute to the extensive and high quality range of NHS services available to them during their stay, in line with their temporary immigration status. It is also right and fair that victims of modern slavery should not pay the charge. I am delighted that this draft order makes this explicit. I beg to move.